Leadership Retreat 2022 Registration

Personal Information

First Name

Last Name

Email Address

Cell Phone

Address 1

Address 2

City

State

Zip Code

Business Information

Name of Church / Ministry / Organization

Job Title

Website

General Phone

general contact email

Address 1

Address 2

City

State

ZIP Code

Family and Lodging Information

If your spouse and/or children plan to accompany you to the retreat, please provide their information below. Otherwise, you may skip this section.

Spouse's Name (if attending)

Spouse's Email (If attending)

Spouse's Cell Phone (If attending)

We're offering Kid Kamp this year! Your children aged 12 months to 12 years/6th grade are welcomed to a retreat all their own! The Kamp will cover all the same meeting/session times that the adults are in, then you'll pick them up during free time. If you're bringing your kids, please give us their first names and ages:

List Children (Names & Ages)

Will you be staying on campus?Yes, I/we will be staying on campusNo, I/we will not be staying on campus

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